Director Highland Hospital The 1,2,3’s of CBD’s Jill A. Antoine MD drjillantoine.com Major US Army ret Director Highland Hospital Perioperative Clinic

Objectives To understand the differences between CBD and THC To understand the medicinal qualities of CBD How to avoid contaminants How and What to purchase to help treat your medical condition How to titrate your dose

Hemp vs Marijuana Both derive from Cannabis sativa species Hemp: THC must be less than .3% Hemp is C sativa L. subsp sativa var. sativa Marijuana is subsp indica or sativa with 2-35% THC Check out Leafly.com

The History One of the earliest plants to be cultivated 8000 BC THC bearing plant occurred in South-central Asia Grown by our forefathers including George Washington Humans have been eating it for centuries Marihuana tax of 1937 GW wrote in his diaries about Hemp and male and female plants and flowers Middle ages in Grmany and Italy used in baking and soups 1937 tax on anyone growing hemp for commercial sale, thought to be competition to wood, nylon, rope from synthetic fibers

What is CBD? Cannabidiol Second most prevalent active ingredient of marijuana Derived from hemp or marijuana, but usually hemp No high=nonpsychoactive Created by Decarboxylation of CBDa You need to ask where the CBD comes from? Is it from Cannabis or Hemp oil

CBD is NOT THC= tetrahydrocannabinol Is one of many Cannabinoids in marijuana CBG or CBC or CBDa THC is psychoactive and responsible for making you high Following decarboxylation, each of the cannabinoid acids yields a corresponding cannabinoid compound: CBG (Cannabigerol) THC (Δ9–tetrahydrocannabinol) CBD (Cannabidiol) CBC (Cannabichromene) CBGV (Cannabigerivarin) THCV (Tetrahydrocannabivarin) CBDV (Cannabidivarin) CBCV (Cannabichromevarin)

Is CBD legal? Feds: CBD = Marijuana as a crime MD’s can now research CBD made illegal in 1970 by Nixon Crime is Schedule one drug banned in 1970 under the Controlled Substances Act Not enforced by feds as crime regularly Many states have vastly different laws. Know yours 16 states as of Sept 2018 have CBD only laws allowing possession and 29 have medical marijuana laws including CBD and 9 states and DC have legalized recreational use for adults With Epidiolex by GW Pharmaceuticals expects it to be reclassified to a Schedule 4 drug like Xanax

California Law on CBD Not Legal CDPH update July 2018: Therefore, although California currently allows the manufacturing and sales of cannabis products (including edibles), the use of industrial hemp as the source of CBD to be added to food products is prohibited. Until the FDA rules that industrial hemp-derived CBD oil and CBD products can be used as a food or California makes a determination that they are safe to use for human and animal consumption, CBD products are not an approved food, food ingredient, food additive, or dietary supplement. Call Scott Wiener our state Senator and email him to legalize CBD and Hemp growing and food use.

CBD Health Benefits Epilepsy Insomnia Anxiety Decreases Pain Decreases Inflammation Neuroprotection Glaucoma Antipsychotic Multiple sclerosis pain Lowers blood sugar Several complex syndromes of childhood such as Dravet syndrome and Lennos-Gastaut syndrome are well studied and a new medication has been approved by the FDA=Epidiolex ( first ever) New studies suggest that CBD helps you fall asleep and stay asleep. More are ongoing. Much better than ambien which is addictive and alters your brain severely i.e. Roseanne barr For pain and inflammation studies have been done on animals in Europe. We need studies in humans. Neuro is NOT like THC which is causing brain damage

Recepetors in Human THC tends to bind receptors in brain: CB1 CBD binds receptors in body: CB2 Humans have endocannabinoid receptors and makes its own CBD’s G protein coupled receptors CB1 and CB2 CB1 is in high levels in the brain in several regions CB2 are ound in Immunce cells and a few neurones

FDA Warnings No claims can be made to health benefits Must develop peer-reviewed, double-blind, placebo-controlled clinical studies

Is CBD safe? Yes….BUT Side Effects: nausea, fatigue, irritability Increases blood levels of medications No regulation so purity and pollution are an issue Some products may not even contain CBD coumadin

How is CBD taken? Oral liquid Vape oil or inhaler Topically Salve Lotion Tincture sublingually spray

How do I pick the right CBD product? No FDA review States with legal marijuana laws have regulated lab testing in dispensaries; CA, WA, CO, OR, Ak, ME, MA, NV, DC Where does it come from? How is it made? What is in it? Questions you must ask before you buy.

Where does it come from? Certified US farms Certified USDA Organic Pesticide free in European Union Roundup free? The state Department of Agriculture certifies this for the states growing it legally. We are NOT yet doing so.

How is CBD Oil made? Organic pharmaceutidal-grade ethanol extraction CO2 extraction Best Bet is to choose either of these methods. CO2 extraction ensures CBD holds its purity

What is in your CBD oil? Make sure your supplier is at least second source verifying Devoid of pesticides, herbicides and solvents No heavy metals Decarboxylated Ask for certificate of analysis or lab report. Do NOT buy without this. Make sure you buy organic at all times. Primary source is verified by the company of production Secondary Source is verifying from other than the primary source manufacturer Hemp is a biozccumulator so it cleans the soil of heavy metals that can get in the plant Decarboylation is heating to create CBD from CBDa

Recommended Products Ojai Energetics, Full Spectrum Hemp Elixir CBDPure, Hemp Oil CW Hemp, Hemp Extract Oil H. Hemp, CBD Infused with MCT oil Sagely Naturals Relief & Recovery Capsules Bluebird Botanicals Hemp Classic Highest concentration Plenty Relief, Concentrated Hemp Oil Pure Spectrum, Hemp Oil Tincture Plus CBD Oil

Research https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2697762 https://www.ncbi.nlm.nih.gov/pmc/?term=CBD J Neuroendocrinol. 2008 May;20 Suppl 1:10-4. doi: 10.1111/j.1365- 2826.2008.01671.x. Cannabinoid receptors: where they are and what they do. Philos Trans R Soc Lond B Biol Sci. 2001 Mar 29;356(1407):381-408. The neurobiology and evolution of cannabinoid signalling. https://www.cdph.ca.gov/Programs/CEH/DFDCS/CDPH%20Document%20Library/ FDB/FoodSafetyProgram/HEMP/Web%20template%20for%20FSS%20Rounded%2 0-%20Final.pdf